Purpose: Bilateral vocal fold immobility (BVFI) presents a challenging endeavor to surgeons and a suture lateralization (SL) procedure under endoscopy has been proposed to treat BVFI. The goal of this study is to introduce an adaptable method to calibrate an appropriate entrance on the thyroid lamina for the stitch canal to precisely reach an appropriate endolaryngeal site for the suture loop placement and minimize the endolaryngeal soft-tissue (ELT) damage. Materials and Methods: From 2007–2015, a total of 38 patients with BVFI due to various causes had undergone 40 exo-endolaryngeal SL (exoeSL) procedures in our hospital. The former 20 patients had undergone so-called blind suture loop placement procedures. The latter 18 patients had been treated with a refined suture placement technique. Results: The suture placement in former 20 patients had undergone one to three episodes of needle entrances into the ELT with average of 1.7 episodes each patient and caused one paraglottic hematoma. The latter 18 of the 38 patients had obtained one episode of ELT damage each patient and produced no vascular events. Conclusions: The topographic relationship of the pyriform recess on the thyroid lamina can serve as a consistent and surgically useful landmark for avoiding the paraglottic dead space infection from the stitching canal during the SL procedure. With this suture placement refinement, the exoeSL procedure can really obtain a relatively appropriate endolaryngeal site to place the suture loop and decrease the ELT damage.